Yoga Therapy is Not Yoga
published in the 2009 issue of the International Journal of Yoga Therapy.
Attending the Council of Schools Initiative at the 2009 Symposium on Yoga Therapy and Research (SYTAR) was an engaging and invaluable experience. Forty representatives from training programs across the U.S. and beyond gathered to exchange ideas and have a lively debate on the future of Yoga therapy.
When I submitted my application to become a Charter Member school, I was curious to see if there would be any sort of vetting process or if the International Association of Yoga Therapists (IAYT) would just cash my check and put me on the list. Much to IAYT's credit, and to my deep appreciation, I received a call from Executive Director John Kepner. We had a lengthy conversation about the training I was offering and IAYT's efforts to tackle the need for standards. It was truly an honor to be invited to attend the Council of Schools meeting and participate in the momentous discussions on standards for training Yoga therapists.
My participation was motivated both by an interest in meeting other Yoga professionals with a therapeutic orientation and by the possible implications that establishing Yoga therapy as a "respected" profession would have on the market branding for my business. I went into the meetings with two basic questions:
1. What, specifically, constitutes Yoga therapy? 2. Does what I am doing meet these criteria?
The answer to these questions hinges on a subtle distinction between two viewpoints, both of which were present at the Council of Schools meeting. For discussion purposes and lack of better terms, I refer to these perspectives here as the Preventative Care Yoga Professional (PCYP), or the wellness viewpoint, and the Clinical Application Yoga Professional (CAYP), or the treatment viewpoint.
There seemed to be a general consensus between both perspectives regarding three basic principles of Yoga therapy:
1. Assessment: The professional has a process for inquiry or formal intake of the student/client's physical and/or mental history. 2. Adaptation: The professional provides or prescribes practice/treatment that meets the individual, multi-dimensional needs of the student/client. 3. Relationship: The practice/treatment relies on a "connection" between the professional and the student/client.
Establishing the specificity of these broad principles is where the perspectives diverged. Depending on the view, each of these three principles assumes very different attributes.
A PCYP/wellness assessment would likely take the form of a casual conversation in which the professional and the student get a sense of each other, discuss any potential issues, and establish the basis for a friendship. A CAYP/treatment assessment would likely mean a more formal intake process in which the professional discusses previous diagnoses, consults with the client's physician (when appropriate), and develops rapport.
The PCYP adapts practice intuitively by offering suggestions and coming to a mutual agreement with the student. The CAYP adapts practice by determining an appropriate practice for the client, based on their condition or on existing protocols.
Both the PCYP and the CAYP rely heavily on establishing rapport with the student/client; however, the context for the relationship differs. A PCYP relates to the student as an equal. The student defers to the professional experience of the PCYP, but ultimately makes his or her own determinations. A CAYP plays a more authoritative role; the client typically trusts the CAYP's judgment and defers to his or her professional expertise.
It is important to note that a CAYP requires more specialized training than does a PCYP. In order to work with more serious illnesses in the context of a clinical environment and in such a way that would earn respect among the medical establishment, a CAYP needs to share knowledge similar to, and speak the same language as, that establishment. A PCYP does not.
There is a strong case to be made for the claim that Yoga therapy should be defined more narrowly to refer only to clinical application. If the purpose of creating standards and accreditation is to bring Yoga into Western medicine and to move Western medicine in a more holistic direction by working from within the system, then it makes no sense to have a preventative care/wellness classification that requires less specialized training standards; this could, in fact, diminish the standing of Yoga therapy and hinder these goals.
However, without a Yoga therapy classification for people working from the wellness perspective, there is no way for people who are not in the medical system to distinguish a PCYP from Yoga teachers who are not employing Yoga therapy principles. Theoretically, all Yoga is inherently therapeutic, but the fact remains that there is an existing system of registration and certification that does not distinguish between approaches. There is also an abundance of Yoga classes on the market that are quite injurious.
When it comes down to what is actually happening "on the mat," so to speak, PCYPs and CAYPs use the same techniques and obtain the same results, only in different contexts. If a person comes to Yoga with a slipped disc and the Yoga professional knows enough to suggest appropriate breathing and moving exercises, if the student's spine heals, is that Yoga therapy? From the treatment viewpoint of Yoga therapy, it would depend on what's going on in the mind of the professional and the credentials on their resume.
Whether Yoga therapy is defined broadly as a way to distinguish a therapeutic orientation from the predominant commercial approaches or more narrowly as a means to integrate Yoga into the healthcare system as a complementary or alternative medicine, the impetus for standards is clearly a desire for professional development and perceived legitimacy. Merits aside, the issues of registration, certification, standards, accreditation, and licensure have little to do with Yoga. As a practical matter, Yoga is inherently mystical and cannot be certified by proclaimed external authorities. Yoga refers to a state that is unencumbered by time, money, or politics. At the heart of the matter is a paradox that requires reconciliation: Yoga therapy is not Yoga.
If the goal is to create standards for Yoga therapy so that accreditation and perhaps licensure can take place, then my input here is counterproductive. However, if the purpose of establishing Yoga therapy as a respected profession is to promote a Yoga practice that applies assessment, adaptation, and relationship, then it's reasonable to question the wisdom of limiting Yoga therapy to clinical environments. Working from within the existing system requires that a hierarchy of knowledge and credentials be created, which lends itself well to classical traditions that also place people in positions of power over others; this presents some disastrous pitfalls as well.
Current mainstream convention is not conducive, if not completely contrary, to Yoga. Consider the influence of institutionalization on the process of birthing children in American hospitals. It is a frightening example of how medical protocols develop that are more about convenience and abating liability than about the best interests of people or a holistic concept of health. Many accredited midwives have stopped working at hospitals and begun doing home births instead, despite the added risk, because they have found it impossible to maintain the depth of their practice under such unharmonious conditions. Conforming to the dictates of an entrenched and corruptive system would potentially serve to only further obscure Yoga.
As with any movement for change, there are those who work from within the system and those who work outside of the system. It remains to be seen whether IAYT represents both or simply the former. In either case, there needs to be a baseline standard for therapeutic Yoga professionals and more extensive standards for clinical Yoga therapists. If Yoga therapy does come to specify a clinical application, I only hope that those who forge that path will not disparage others who choose to go another way.